Provider Demographics
NPI:1437656840
Name:INNOVATIONS FOR AGING, LLC
Entity type:Organization
Organization Name:INNOVATIONS FOR AGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-917-4649
Mailing Address - Street 1:3001 BROADWAY ST NE STE 170
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2374
Mailing Address - Country:US
Mailing Address - Phone:651-641-8612
Mailing Address - Fax:
Practice Address - Street 1:3001 BROADWAY ST NE STE 170
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2374
Practice Address - Country:US
Practice Address - Phone:651-641-8612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty